Provider Demographics
NPI:1558634519
Name:TAKENISHI, PAT (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAT
Middle Name:
Last Name:TAKENISHI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S BERETANIA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2414
Mailing Address - Country:US
Mailing Address - Phone:808-691-8925
Mailing Address - Fax:808-691-8926
Practice Address - Street 1:550 S BERETANIA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2414
Practice Address - Country:US
Practice Address - Phone:808-691-8925
Practice Address - Fax:808-691-8926
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-1967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist